infection control & hospital epidemiology october 2015, vol. 36, no. 10 original article
Gap Analysis of Infection Control Practices in Low- and Middle-Income Countries
Kristy Weinshel, MBA;1 Angela Dramowski, MBChB, FCPaed, MMed;2 Ágnes Hajdu, MD;3 Saul Jacob, MD;4 Basudha Khanal, MD;5 Maszárovics Zoltán, MD;6 Katerina Mougkou, MD;7 Chimanjita Phukan, MD;8 Maria Inés Staneloni, MD;9 Nalini Singh, MD, MPH10
background. Healthcare-associated infection rates are higher in low- and middle-income countries compared with high-income countries, resulting in relatively larger incidence of patient mortality and disability and additional healthcare costs.
objective. To use the Infection Control Assessment Tool to assess gaps in infection control (IC) practices in the participating countries.
methods. Six international sites located in Argentina, Greece, Hungary, India, Nepal, and South Africa provided information on the health facility and the surgical modules relating to IC programs, surgical antibiotic use and surgical equipment procedures, surgical area practices, sterilization and disinfection of equipment and intravenous fluid, and hand hygiene. Modules were scored for each country.
results. The 6 international sites completed 5 modules. Of 121 completed sections, scores of less than 50% of the recommended IC practices were received in 23 (19%) and scores from 50% to 75% were received in 43 (36%). IC programs had various limitations in many sites and surveillance of healthcare-associated infections was not consistently performed. Lack of administration of perioperative antibiotics, inadequate sterilization and disinfection of equipment, and paucity of hand hygiene were found even in a high-income country. There was also a lack of clearly written defined policies and procedures across many facilities.
conclusions. Our results indicate that adherence to recommended IC practices is suboptimal. Opportunities for improvement of IC practices exist in several areas, including hospital-wide IC programs and surveillance, antibiotic stewardship, written and posted guidelines and policies across a range of topics, surgical instrument sterilization procedures, and improved hand hygiene.
Infect. Control Hosp. Epidemiol. 2015;36(10):1208–1214
Healthcare-associated infections (HAI) have been a major global priority with higher rates in developing countries.1 Surgical site infections (SSI) are more common in these countries and the high incidence can be associated with low socioeconomic level.2 The most recent estimates in developing countries found the prevalence of HAI to be 15·5 per 100 patients (95%, CI 12.6–18.9)with SSI being the most common infection.3 By comparison, the HAI prevalence in the United States was found to be much lower at 4 per 100 patients, though SSI was still one of the most common infections.4 There are limited studies on the impact of HAI in developing countries, but these infections have been shown to increase length of stay, mortality, and cost.5 The financial burden of HAI includes direct costs to the hospital for prolonged stay and readmission, as well as costs to the community and the patients
themselves.6 Many global initiatives have addressed these higher rates of HAI and SSI in developing countries with programs such as continuous quality improvement efforts,7,8 antimicrobial stewardship,9 use of checklists,10 and infection prevention guidelines for facilities with limited resources.11 Multiple tools have been developed for the assessment of infection control (IC) by the World Health Organization12 and the US Agency for International Development has created the Infection Control Assessment Tool (ICAT).13 The ICAT was developed with the aim of clearly identifying targets for improved IC practice that would contribute to lowering of HAI rates in low-resource healthcare facilities.14,15 Owing to concern for higher rates of HAI in developing countries and the high prevalence of SSI, we set out to further investigate specific areas where IC practices could be improved.
Affiliations: 1. Society for Healthcare Epidemiology of America, Arlington, Virginia; 2. Stellenbosch University, Cape Town, South Africa; 3. National
Center for Epidemiology, Budapest, Hungary; 4. George Washington University, Washington, DC; 5. B. P. Koirala Institute of Health Sciences, Nepal; 6. Markhot Ferenc Teaching Hospital and Outpatient Clinic, Eger, Hungary; 7. National Kapodistrian University, Athens School of Medicine, Athens, Greece; 8. Gauhati Medical College and Hospital, Guwahati, India; 9. Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; 10. Children’s National Medical Center, George Washington University, Washington, DC.
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved. 0899-823X/2015/3610-0011. DOI: 10.1017/ice.2015.160 Received March 3, 2015; accepted June 11, 2015; electronically published July 22, 2015
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